Noticing bleeding gums while brushing or flossing can cause alarm. Often the cause of bleeding gums is as simple as brushing too hard, but in some instances it can be a symptom of something more serious.

Bleeding Gums Causes

One of the biggest bleeding gums causes is the buildup of plaque on the teeth. If left unaddressed this will lead to gingivitis, an early stage of gum disease. Alongside bleeding gums, symptoms of gingivitis include red and puffy gums.

Gingivitis occurs when plaque, which contains bacteria, builds up on teeth and produces toxins that irritate the gums. Signs of gingivitis include bleeding, puffy, sore, inflamed or red gums. Managing gingivitis is important so that it doesn’t progress into a more serious form of gum disease.

Here are some important ways to help manage gingivitis, and remember, it’s all about keeping your teeth as free from plaque as possible:

Brush thoroughly twice a day with an antigingivitis toothpaste.

Rinse thoroughly with an antigingivitis mouthwash.

Use a soft bristled manual or electric rechargeable toothbrush.

Floss daily.

Visit your dental professional regularly.

Causes and Treatment of Pregnancy Gingivitis

Pregnancy gingivitis is caused by a rise in the hormone progesterone which can contribute to an increase in the flow of blood to gum tissues making them sensitive, swollen and more likely to bleed when you brush and floss. These hormonal changes can make it easier for certain gingivitis-causing bacteria to grow and can make gum tissue more tender. While pregnancy gingivitis can occur anytime between the second and eight month, it’s usually more severe during the second trimester.

Controlling plaque is the most important thing you can do to prevent problems with pregnancy gingivitis. A strict home care routine of proper and meticulous plaque removal should start even before you are pregnant. Not all oral care products are the same, so be sure to choose a toothpaste and mouthwash designed to treat plaque and gingivitis. Also try a soft electric rechargeable brush to make plaque removal easier.

Blood thinning medications may also cause your gums to bleed. If you think your bleeding gums might be due to medication, get in touch with your dentist.

Bleeding Gums Treatment

The best way to find out the cause of your bleeding gums is to book an appointment with a dental professional. Your dentist or dental hygienist will be able to advise you on the best bleeding gums treatment according to your symptoms.

WHAT IS ROOT CANAL TREATMENT?

If your tooth’s nerve chamber becomes infected by decay, or damaged by injury, root canal treatment is often the only way to save your tooth.

Inside the enamel (hard outer shell of the tooth) is a specific area called the pulp or nerve chamber. The pulp chamber contains blood vessels and nerves to provide nutrients for the tooth.

Deep cavities or other injury can cause damage to or infection of the tooth pulp. In a root canal, the dentist removes the damaged or infected pulp and replaces it with a special filler which helps protect the rest of the tooth. This filler will probably last a lifetime but you may need a new filling or a cap on the tooth. Without root canal treatment, the gum and bone around the tooth may become infected and a painful gumboil may form.

Quick Facts about root canal treatment:

You may need root canal treatment if you have:

Pain or throbbing while biting

Pain when eating/drinking hot or cold beverages/foods

Deep cavity or injury that causes an infection in the bone

Color change/darkening of the tooth

Swelling in nearby gum

Here are some ways to help prevent root canal treatment:

Brush and floss your teeth twice a day. Use a soft toothbrush and a fluoride toothpaste.

Visit your dentist regularly to have your teeth checked.

Have cavities fixed early so that infection cannot reach the nerve of the tooth.

If playing a contact sport, ask your dentist about wearing a mouth guard.

If your mouth and/or teeth are hurt, have them checked by a dentist as soon as possible.

Be sure to follow the special home care instructions provided by your dentist.

What Is Apicoectomy?

Your teeth are held in place by roots that extend into your jawbone. Front teeth usually have one root. Other teeth, such as your premolars and molars, have two or more roots. The tip of each root is called the apex. Nerves and blood vessels enter the tooth through the apex, travel through a canal inside the root, and into the pulp chamber, which is inside the crown (the part of the tooth visible in the mouth).

An apicoectomy may be needed when an infection develops or persists after root canal treatment,or retreatment. During root canal treatment, the canals are cleaned, and inflamed or infected tissue is removed. Root canals are very complex, with many small branches off the main canal. Sometimes, even after root canal treatment, infected debris can remain in these branches and possibly prevent healing or cause re-infection later. In an apicoectomy, the root tip, or apex, is removed along with the infected tissue. A filling is then placed to seal the end of the root.

An apicoectomy is sometimes called endodontic microsurgery because the procedure is done under an operating microscope.

What It’s Used For

If a root canal becomes infected again after a root canal has been done, it’s often because of a problem near the apex of the root. Your dentist can do an apicoectomy to fix the problem so the tooth doesn’t need to be extracted. An apicoectomy is done only after a tooth has had at least one root canal procedure.

In many cases, a second root canal treatment is considered before an apicoectomy. With advances in technology, dentists often can detect additional canals that were not adequately treated and can clear up the infection by doing a second root canal procedure, thus avoiding the need for an apicoectomy.

An apicoectomy is not the same as a root resection. In a root resection, an entire root is removed, rather than just the tip.

Preparation

Before the procedure, you will have a consultation with your dentist. Your general dentist can do the apicoectomy, but, with the advances in endodontic microsurgery, it is best to be referred to an endodontist.

Your dentist may take X-rays and you may be given an antimicrobial mouth rinse, anti-inflammatory medication and/or antibiotics before the surgery.

If you have high blood pressure or know that you have problems with the epinephrine in local anesthetics, let your dentist know at the consultation. The local anesthetic used for an apicoectomy has about twice as much epinephrine (similar to adrenaline) as the anesthetics used when you get a filling. The extra epinephrine constricts your blood vessels to reduce bleeding near the surgical site so the endodontist can see the root. You may feel your heart rate speed up after you receive the local anesthetic, but this will subside after a few minutes.

How It’s Done

The endodontist will cut and lift the gum away from the tooth so the root is easily accessible. The infected tissue will be removed along with the last few millimeters of the root tip. He or she will use a dye that highlights cracks and fractures in the tooth. If the tooth is cracked or fractured, it may have to be extracted, and the apicoectomy will not continue.

To complete the apicoectomy, 3 to 4 millimeters of the tooth’s canal are cleaned and sealed. The cleaning usually is done under a microscope using ultrasonic instruments. Use of a surgical microscope increases the chances for success because the light and magnification allow the endodontist to see the area better. Your endodontist then will take an X-ray of the area before suturing the tissue back in place.

Most apicoectomies take between 30 to 90 minutes, depending on the location of the tooth and the complexity of the root structure. Procedures on front teeth are generally the shortest. Those on lower molars generally take the longest.

Follow-Up

You will receive instructions from your endodontist about which medications to take and what you can eat or drink. You should ice the area for 10 to 12 hours after the surgery, and rest during that time.

The area may bruise and swell. It may be more swollen the second day after the procedure than the first day. Any pain usually can be controlled with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofem (Advil, Motrin and others) or prescription medication.

To allow for healing, you should avoid brushing the area, rinsing vigorously, smoking or eating crunchy or hard foods. Do not lift your lip to examine the area, because this can disrupt blood-clot formation and loosen the sutures.

You may have some numbness in the area for days or weeks from the trauma of the surgery. This does not mean that nerves have been damaged. Tell your dentist about any numbness you experience.

Your stitches will be removed 2 to 7 days after the procedure, and all soreness and swelling are usually gone by 14 days after the procedure.

Even though an apicoectomy is considered surgery, many people say that recovering from an apicoectomy is easier than recovering from the original root-canal treatment.

Risks

The endodontist will review the risks of the procedure at the consultation appointment. The main risk is that the surgery may not work and the tooth may need to be extracted.

Depending on where the tooth is located, there may be other risks. If the tooth is in the back of your upper jaw, the infection can involve your sinuses, and your dentist may suggest antibiotics and decongestants. The roots of the back teeth in the lower jaw are close to some major nerves, so surgery on one of these teeth carries a slight risk of nerve damage. However, your endodontist will use your X-rays to see how close the roots are to the nerves, and the chances of anything happening are extremely small.

An apicoectomy is usually a permanent solution, and should last for the life of the tooth.

When To Call a Professional

If you’re having any pain or swelling from a tooth that has had root-canal treatment, contact your dentist, who will take X-rays and do an exam. If your dentist feels you need an apicoectomy, you will need to set up an appointment for a consultation.

Endodontics is the branch of dentistry that deals with diseases of the tooth’s pulp. The pulp is found in the center of the tooth and in canals (called root canals) inside the root of each tooth. Pulp includes connective tissue, nerves and blood vessels. Pulp nourishes the tooth when it first emerges through the gum. Once the tooth matures, the pulp can be removed without destroying the tooth. That’s because each tooth also is nourished by a blood supply in the gums.

Removing the pulp is called endodontic treatment, but it is often referred to as root canal treatment or root canal therapy. Many people refer to pulp removal as “having a root canal.” Root canal treatments are quite common. In the United States, they save about 24 million teeth each year.

Why Would You Need Root Canal Treatment?

Root canal treatment is needed for two main reasons. The first is infection. An untreated cavity is a common cause of pulp infection. The infection destroys the enamel and dentin of the tooth until it reaches the pulp. Bacteria then infect the pulp. Antibiotics can’t reach all the bacteria inside a canal. They are given to reduce the number of bacteria that spread outside the canal and into the bone. The inflammation caused by the infection reduces the blood supply to the tooth. The reduced blood supply also keeps the pulp from healing.

The second reason for a root canal is damage to the pulp that can’t be fixed. A fracture in a tooth can damage the pulp. So can a less severe blow to the tooth (trauma), even if there’s no visible damage right away. In time, the tooth may darken because of bleeding within the pulp.

Sometimes, common dental procedures can hurt the pulp. For example, this can occur if a tooth is cut too close to the pulp while it’s being prepared for a filling or a crown. Then the tooth might need a root canal.

When the pulp is inflamed but not infected, it may heal on its own. The pulp is able to fight off some bacteria. Your dentist may want to see if this will happen before doing root canal treatment. If the pulp remains inflamed, it can become painful.

An infection in the pulp can affect the bone around the tooth. This can cause an abscess to form. The goal of root canal treatment is to save the tooth by removing the infected or damaged pulp, treating any infection, and filling the empty root canals with a material called gutta percha.

If root canal treatment is not done, an infected tooth may have to be extracted. It is better to keep your natural teeth if you can. If a tooth is missing, neighboring teeth can drift out of line. Keeping your natural teeth also helps you to avoid other treatments, such as implants or bridges. Also, if you ignore an infected or injured tooth the infection can spread to other parts of your body.

Having root canal treatment on a tooth does not mean that the tooth will need to be pulled out in a few years. Once a tooth is treated, and restored with a filling or crown, it often will last the rest of your life.

Signs and Symptoms

If you have an infection of the pulp, you may not feel any pain at first. But if it is not treated, the infection will cause pain and swelling. In some cases, an abscess will form.

Your tooth might need a root canal if:

It hurts when you bite down on it, touch it or push on it

It is sensitive to heat

It is sensitive to cold for more than a couple of seconds

There is swelling near the tooth

It is discolored (whether it hurts or not)

It is broken

To determine whether your tooth needs root canal treatment, your dentist will often place hot or cold substances against the tooth. The purpose is to see if it is more or less sensitive than a normal tooth. He or she will examine the tissues around the tooth and gently tap on the tooth to test for symptoms.

Even if you have an infection in the pulp, you may not have any pain. Sometimes the infection finds a way out through the bone, creating a tunnel called a fistula, where the pus can drain. Since there is no pressure build-up in the area, you will not feel pain. The tooth will need a root canal.

You also will be given X-rays of the tooth and the bone around the tooth. The X-rays may show a widening of the ligament that holds the tooth in place or a dark spot at the tip of the root. If either of these is present, your dentist probably will recommend a root canal procedure.

Your dentist may need more information about the tooth. He or she may use an electric pulp tester. This hand-held device sends a small electric current through the tooth. It helps your dentist decide whether the pulp is alive. This test does not cause pain or a shock. You may feel a tingling sensation. It will stop when the tester is removed from the tooth.

Length of Treatment

Root canal treatment can be done in one or more visits. It depends on the situation. An uncomplicated root canal treatment often can be completed in one visit. Some teeth have more roots than other teeth. Treating a tooth with many roots takes longer. Some teeth have curved root canals that are difficult to find. Typically, teeth with active infections require more than one visit.

Once the root canal treatment is finished, you will need to see your general dentist to have a crown or filling placed on the tooth. You are likely to receive a crown if the tooth is discolored or is significantly broken down. Teeth become brittle after root canal treatment. The purpose of the crown is to prevent the tooth from breaking in the future. If most of the enamel is intact, a composite filling can be used to seal the canal.

Measuring and Cleaning the Root Canals

First, your dentist or endodontist will numb the area around the tooth. You also may receive sedation, such as nitrous oxide. Your dentist also has other ways to reduce your anxiety. Before your first appointment, ask what is available.

A small protective sheet called a dental dam will be placed over the tooth to keep the area free of saliva. Then the dentist will make a hole in the top or back of your tooth to get to the pulp chamber. He or she will remove some of the diseased pulp.

Then the root canals have to be measured. Your dentist needs to know how long the canals are to make sure the entire canal is cleaned. He or she also needs to know how much filling material to put in the cleaned canals.

To measure the root canals, dentists use X-rays or an electric device called an apex locator. For an X-ray, your dentist will place a file into the canal and then take an X-ray. An apex locator measures a root canal based on its resistance to a small electric current. Many dentists use both methods.

After the canals have been measured, your dentist or endodontist will use special tools to clean out all of the diseased pulp and infected parts of the canal wall. Then the canal is cleaned with antiseptic. This helps treat and prevent infection. All the canals within a tooth must be cleaned. Teeth have different numbers of canals:

The top front teeth have one canal.

The bottom front teeth have one or two canals.

The premolars have one or two canals.

The molars have three or four canals.

The location and shape of the canals can vary quite a bit. Some endodontists look inside the tooth with a microscope to make sure all the canals have been cleaned out.

Once the canals have been thoroughly cleaned, the roots are filled. A temporary filling is placed over the tooth. This is replaced as soon as possible with a permanent filling or crown.

In most cases, the tooth will need a crown. A crown will help to restore the tooth’s strength and protect it from cracking. If a crown is indicated, it should be placed soon after you have root canal treatment. If the temporary filling is left too long, the bacteria from your mouth will reinfect the tooth.

The pulp that was removed during root canal treatment is the part that responds to temperature. Your tooth will no longer be sensitive to hot or cold after the root canal is treated. There still are tissues and nerves around the tooth, however, so it will respond to pressure and touch.

After Root Canal Treatment

Your tooth may be sore for two to three days after the procedure. The worse the infection and inflammation you had, the more sensitive the tooth will be after treatment. Avoid chewing on the affected side. You can take over-the-counter pain relievers. A pain reliever that also reduces inflammation is likely to be most helpful. Examples include ibuprofen and aspirin.

Possible Complications

As with most invasive medical or dental procedures, complications can occur. Here are some possibilities.

Sometimes when a root canal is opened for treatment, the oxygen in the air will trigger some bacteria to start growing. This causes swelling and pain.

Blood vessels enter the tooth through a small hole at the bottom of the root. Sometimes during a root canal procedure, bacteria are pushed through this hole into surrounding tissue. If this happens, the surrounding tissue will become inflamed and possibly infected. This can be treated with painkillers and sometimes antibiotics. However, it may be painful until it clears up.

A root canal treatment can puncture the side of the tooth. This can happen if a canal is curved or hard to find. The tools that the dentist uses are flexible. They bend as a canal curves. Sometimes they bend at the wrong time and make a small hole in the side of the tooth. It will have to be filled. Sometimes the tooth has to be removed.

Finding root canals can be difficult. If all of the canals aren’t found and cleaned out, the tooth can stay infected. This also can happen if a canal isn’t measured correctly and pieces of infected or inflamed pulp are left near the bottom. In this case, the root canal procedure would have to be done again. Occasionally, root canals have branches that the dentist’s tools can’t reach.

The tip of a file may break off inside the tooth. If the canal is clean, your dentist can leave the piece of file in the tooth. But if canal is not completely cleaned out, the file piece may have to be removed. Sometimes this can be done from the top of the tooth. However, in some cases, the file can only be removed through a surgical procedure called an apicoectomy. A small cut (incision) is made in the gum, at the end of the tooth’s root, so the dentist can get to the bottom of the root. The dentist shaves off the bottom of the root and gets into the canal from the bottom to remove the file piece.

Pain, or the Lack of It

In most cases, you will not have any pain during a root canal procedure. Your dentist will numb your tooth and the surrounding area. Let your dentist know if you are feeling any pain during the root canal. Some people fear the numbing shot more than the root canal treatment itself. Today, numbing gels and modern injection systems have made injections virtually painless.

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